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Summary¶The variability of the winter mean precipitation observed at 40 rainfall stations in Emilia-Romagna (a region in northern Italy) from 1960 to 1995 is examined. The results are compared with those obtained for the whole of Italy using records from 32 stations. Temporal variability of the time series is investigated by means of Mann-Kendall and Pettitt tests, in order to estimate the presence of trends and “change points”. Before analysis the original precipitation data set have been tested to detect the inhomogeneity points, using the Standard Normal Homogeneity Test (SNHT). Almost all stations situated in Emilia Romagna exhibit a significant decreasing trend in winter precipitation during the 1960–1995 period. The same characteristics are revealed, more significant in the northern and central part of the region, when the stations for all Italy are analysed. A significant downward shift in the winter precipitation is detected through the Pettitt test in Emilia Romagna, around 1980 at some stations, while the rest of the stations reveal the shift point occurrence around 1985. A significant downward shift in the winter precipitation is detected around 1985, when analysing the time series for all Italy. Spatial variability of winter precipitation is studied using the Empirical Orthogonal Function. The first pattern indicates that a common large-scale process could be responsible for the winter precipitation variability. The second EOF pattern shows an opposite sign of climate variability, which highlights the influence of relief on the precipitation regime. The time series associated with the first precipitation pattern (PC1) at both scales emphasises a significant decreasing trend and a downward shift point around 1985. The internal structure analysis of the North Atlantic Oscillation (NAO) index during the 1960–1995 period reveals a significant increasing trend and an upward shift around 1980. Strong correlation is also detected between PC1 (Emilia Romagna and at the scale of all Italy) and the NAO index. Thus, the changes detected in the winter precipitation around 1985 could be due to an intensification of the positive phase of the [NAO], especially after 1980. [ABSTRACT FROM AUTHOR]

In February 2020 the first COVID-19 case was reported in Italy and afterwards the virus started spreading rapidly, increasing dramatically the number of infected subjects. To face the pandemic outbreak, hospitals converted wards to assure COVID-19 patients' care and adopted measures to reduce virus diffusion. The aim of this study was to determine how many physiotherapists, in the Lombardy region, worked during pandemic, whether they continued their usual practice or were employed in COVID-19 wards and in which tasks they were involved. The survey was submitted online by the national professional order. The response rate was 11.79%. During the pandemic, 648 (53.9%) respondents interrupted their services. Less than 20% of the physiotherapists that continued working were assigned to COVID-19 wards with the role of physiotherapist. Only a small proportion of respondents had advanced skills in respiratory physiotherapy. Moreover, this study showed a limited involvement of physiotherapists inside the very acute and intense settings. In conclusion, this work revealed that, during COVID-19 pandemic, in the Lombardy region a small percentage of physiotherapists was employed in COVID-19 wards, mainly in post-acute context. Even though the response rate of this survey was very low, this study highlights the need to define and underline the role of physiotherapy in acute setting during emergency.

Purpose: To investigate the clinical performance of a new mRNA-based urine test, aiming to avoid unnecessary follow-up cystoscopy in patients under active surveillance (AS) for recurrent NMIBC., Methods: This is a prospective cohort study enrolling patients with history of low-grade (LG) NMIBC, who developed a recurrence during the follow-up and underwent AS. Their urinary samples were analyzed by Xpert BC Monitor (Cepheid, Sunnyvale, CA, USA). The primary endpoint was to investigate if Xpert BC Monitor could avoid unnecessary cystoscopy during the follow-up period. Its sensitivity, specificity, PPVs and NPVs were calculated. A cutoff of 0.4 "linear discriminant analysis" (LDA) was optimized for the AS setting., Results: The cohort consisted of 106 patients with a mean age of 72 ± 9.52 and a median follow-up from AS start of 8.8 (range 0-56.5) months. No statistically significant difference was found for the mean age, smoker status, lesion size, and number of lesions with a cutoff of 0.4. Of 106 patients, 22 (20.8%) were deemed to require treatment because of cystoscopic changes in size and/or number of lesions during the follow-up period. Using a cutoff value of < 0.4, 34 (33.7%) cystoscopies could be avoided due to low LDA value, missing 2/22 (9%) failures, none with high-grade (HG) NMIBC. Further research on larger population remains mandatory before its clinical use., Conclusion: Xpert BC Monitor seems to be a reliable assay, which might avoid unnecessary cystoscopies without missing HG NMIBC when its cutoff is optimized for the AS setting.

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.

Due to the exponential growth of the number of subjects affected by coronavirus disease 2019 (COVID-19), the entire Italian health care system had to respond promptly and in a very short time with the need of semi-intensive and intensive care units. Moreover, trained dedicated COVID-19 teams consisting of physicians were coming from different specialties (intensivists or pneumologists and infectiologists), while respiratory therapists and nurses have been recruited to work on and on without rest. However, due to still limited and evolving knowledge of COVID-19, there are few recommendations concerning the need in respiratory rehabilitation and physiotherapy interventions. The presentation of this paper is the result of a consensus promoted by the Italian societies of respiratory health care professionals who contacted pulmonologists directly involved in the treatment and rehabilitation of COVID-19. The aim was to formulate the more proper and common suggestions to be applied in different hospital settings in offering rehabilitative programs and physiotherapy workforce planning for COVID-19 patients. Two main areas of intervention were identified: organization and treatment, which are described in this paper to face the emergency., (© 2020 S. Karger AG, Basel.)

Background: The benefit of pulmonary rehabilitation (PR) in symptomatic chronic obstructive pulmonary disease (COPD) is well known. However, advanced patients with chronic respiratory failure (CRF), a category excluded from most studies, are frequently unable to sustain a work-load sufficiently high to obtain the full benefit of PR on exercise tolerance. Recent studies involving heated and humidified high flow oxygen therapy (HFOT) showed positive effects on breathing pattern and ventilatory efficiency during effort. We thus plan to compare, in COPD patients with CRF undergoing a high-intensity exercise programme, the effect of using HFOT versus standard oxygen delivery via Venturi Mask (V-mask), at the same inspiratory oxygen fraction, on improving exercise endurance., Methods/design: This is a multicentre randomised controlled trial that will involve 156 COPD inpatients with CRF recruited from seven PR hospitals. Patients will be randomised to one of two groups - V-mask versus HFOT. All patients will undergo the same high-intensity exercise programme using either of the oxygen delivery devices as per their group allocation. Training will consist of 20 sessions, over 1 month (5 sessions per week) within the hospitalisation period. Anthropometric and clinical data, including body mass index, diagnosis, spirometry and comorbidities (Cumulative Rating Scale) will be collected at baseline. At baseline and at the end of the exercise programme (primary assessment time) evaluation will include exercise tolerance (Constant Work Rate Exercise Test) (primary outcome), functional capacity (6-min walk test), maximal inspiratory pressure/maximal expiratory pressure, peripheral muscle strength (biceps and quadriceps) by manual dynamometer, respiratory exchanges (blood gases analysis), disability (Barthel Index and Barthel Dyspnoea Index), impact of disease (COPD Assessment test), and quality of life (Maugeri Respiratory Failure Scale-26). At the end of the training period, patient satisfaction will be evaluated., Discussion: This study will add knowledge about the exercise response in advanced COPD with CRF and verify if an alternative tool, namely HFOT, can increase the benefit obtained from PR., Trial Registration: ClinicalTrials.gov ID NET03322787 Registered: 6 November 2017.

Background: It has been shown that active surveillance (AS) is feasible and effective in a subset of patients with recurrent low-grade (LG) non-muscle-invasive bladder cancer (NMIBC)., Objective: To update a previous preliminary series and investigate pathological outcomes for patients who failed to remain on AS., Design, Setting, and Participants: Prospective observational cohort study started in February 2008, and currently still active, at a tertiary university hospital, including patients with pathologically confirmed NMIBC who experienced recurrence during follow-up., Intervention: AS monitoring consisted of cytology and in-office flexible cystoscopy every 3 mo for the first year, and every 6 mo thereafter., Outcome Measurements and Statistical Analysis: The primary endpoint was pathological results for patients who failed to remain on AS. The secondary outcome was an update of clinical results from our previous series. Data were complemented by descriptive statistical analysis and univariable and multivariable proportional hazards Cox regression., Results and Limitations: Overall, 167 patients were included. Of 181 AS events, 61 (33.7%) were deemed to require treatment because of positive cytology (n=10), gross haematuria (n=11), and increases in the tumour number (n=15), or size (n=17), or both (n=8). The median time on AS was 12 mo (interquartile range 4-26). Pathological specimens from AS failures did not show any malignancy in 20 cases. Histopathology identified urothelial hyperplasia and oedema, submucosal vascular ectasia, mucosal erosion, polypoid cystitis, von Brunn nest hyperplasia, and squamous metaplasia. The time from first transurethral resection to AS start was inversely associated with recurrence-free survival (hazard ratio 0.97, 95% confidence interval 0.96-1.00; p=0.024). The study lacks statistical subanalyses focusing on patients with failure and negative neoplastic pathological outcomes., Conclusions: AS might be a reasonable strategy in patients presenting with small LG pTa/pT1a recurrent bladder tumours. Approximately 30% of patients deemed to have AS failure did not harbour any neoplastic lesion, strengthening the role of AS., Patient Summary: Patients with small low-grade pTa/pT1a recurrent papillary bladder tumours could benefit from an active surveillance protocol with no significant risk of pathological progression to muscle-invasive cancer., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer., Materials and Methods: This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1-2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done., Results: Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5-26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence-free survival (HR 0.99, 95% CI 0.98-1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94-1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06-2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was €1,378 for each intervention avoided., Conclusions: Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the results of various reconstructive surgical procedures in patients with failed hypospadias repair., Methods: We performed a retrospective, observational, descriptive chart analysis of patients treated for complications after primary hypospadias repair at two tertiary European centers from 1998 to 2007. Study inclusion criteria were: patients presenting urethral, glans or corpora cavernosa defects and/or penile and genital deformities. Exclusion criteria were: precancerous or malignant penile lesions, incomplete data on medical charts and any condition that would interfere with the patient's ability to provide an informed consent. Preoperative evaluation included urine culture, urethrography and urethroscopy. The patients were classified into four groups according to the type of surgery. Success was defined as a normal functional urethra with apical meatus, no residual chordee or cosmetic deformity of the genitalia. The need for meatal or urethral dilation, complications or poor cosmesis requiring revision was considered a failure., Results: A total of 1.176 patients(mean age 31 years) were evaluated and treated. Nine hundred fifty-three patients (81% ) were treated in Serbia and 223 (19% ) in Italy. Mean follow-up was 60.4 months. Group 1 included 301 patients (25.6% ) who underwent urethroplasty. Group 2 included 60 patients (5.1% ) who underwent corporoplasty. Group 3 included 166 patients (14.1% ) who underwent urethroplasty and corporoplasty. Group 4 included 649 patients (55.2% ) requiring complex resurfacing of the genitalia. Evaluations were scheduled 3, 6 and 9 months postoperatively and annually thereafter. At follow-up, patients underwent a physical examination and uroflowmetry. Out of the 1.176 cases, 1.036 (88.1% ) were classified as successful and 140 (11.9% ) as failures. The success rate was 89.7% in Group 1, 96.7% in Group 2, 88.5% in Group 3, and 86.4% in Group 4, respectively., Conclusions: Failed hypospadias presents a variety of surgical difficulties. Patients requiring complex repair should be referred to a specialized center of expertise.

Background: Although the incidence of iatrogenic ureteral strictures is low, the treatment remains challenging., Objective: To report our technique of robot-assisted uretero-ureterostomy (RAUU) for adults with iatrogenic lumbar and iliac stricture., Design, Setting, and Participants: A descriptive study was performed by our department. Since April 2009, five patients underwent RAUU: Two patients had developed a lumbar or iliac ureteral stricture following a ureterorenoscopy, one had ureteral catheter positioning, one had colon surgery, and one had resection of retroperitoneal cystic lymphangioma. Preoperative evaluation includes history, computed tomography (CT) scan, and mercaptoacetyltriglycine-3 (MAG3) diuretic renal scan., Surgical Procedure: A flank position was used for all patients with lumbar stenosis. A supine position with the bed turned 30° was required for iliac stricture. The optical port, two 8-mm robotic ports, and one 5-mm assistant port were used. A precise definition of the site and extension of the stricture was done using the flexible ureterorenoscope. After the stricture resection, the anastomosis was performed with two running sutures on a ureteral double-J stent., Measurements: Success was defined as no postoperative symptoms and evidence of no obstruction at the CT/urography and at the MAG3 scan at 6-mo follow-up., Results and Limitations: RAUU was technically feasible in all five patients. Average operating time was 135min, and median hospital stay was 3 d. No significant complications occurred. Absence of stricture recurrence and no reduction of kidney function were confirmed by CT/urography and MAG3 scans. At a mean follow-up of 8 mo, all patients were asymptomatic. The main limitations were the short follow-up and the small sample size., Conclusions: RAUU is feasible and safe for repairing iatrogenic lumbar and iliac ureteral strictures. The flexible ureterorenoscopy is useful to localise the obstruction and to correctly define its site and extension to spare as much ureter as possible., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Total prostate-specific antigen (tPSA), ratio of free PSA (fPSA) to tPSA (%fPSA), and PSA density (PSAD) testing have a very low accuracy in the detection of prostate cancer (PCa). There is an urgent need for more accurate biomarkers., Objective: To compare the diagnostic accuracy of PSA isoform p2PSA and its derivatives in determining the presence of PCa at initial biopsy with the accuracy of other predictors in patients with tPSA 2.0-10 ng/ml., Design, Setting, and Participants: We conducted an observational prospective study in a real clinical setting of consecutive men with tPSA 2.0-10 ng/ml and negative digital rectal examination who were scheduled for prostate biopsy at a tertiary academic center., Intervention: Outpatient transrectal ultrasound-guided prostate biopsies were performed according to a standardized institutional saturation scheme (18-22 cores)., Measurements: We determined the diagnostic accuracy of serum tPSA, %fPSA, PSAD, p2PSA, %p2PSA [(p2PSA/fPSA)×100] and the Beckman Coulter Prostate Health Index (phi; [p2PSA/fPSA×√tPSA])., Results and Limitations: Overall, 107 of 268 patients (39.9%) were diagnosed with PCa at extended prostate biopsies. Statistically significant differences between patients with and without PCa were observed for age, prostate and transition zone volume, PSAD, %p2PSA, and phi (all p values<0.05). In univariate accuracy analysis, phi and %p2PSA were the most accurate predictors of PCa (area under the curve: 75.6% and 75.7%, respectively), followed by transition zone volume (66%), prostate volume (65%), patient age (63%), PSAD (61%), %fPSA (58%), and tPSA (53%). In multivariate accuracy analyses, both phi (+11%) and %p2PSA (+10%) significantly improved the accuracy of established predictors in determining the presence of PCa at biopsy (p<0.001). Although %p2PSA and phi were significantly associated with Gleason score (Spearman ρ: 0.303 and 0.387, respectively; p ≤ 0.002), they did not improve the prediction of Gleason score ≥7 PCa in multivariable accuracy analyses (p > 0.05)., Conclusions: In patients with a tPSA between 2.0 and 10 ng/ml, %p2PSA and phi are the strongest predictors of PCa at initial extended biopsies and are significantly more accurate than the currently used tests (tPSA, %fPSA, and PSAD) in determining the presence of PCa at biopsy., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: The aim of this study was to translate and validate in Italian the condition-specific patient-reported outcome measure for urethral stricture surgery (PROM-USS-Q) and evaluate its psychometric properties to determine whether it was suitable for routine use., Methods: We translated the English version; 52 men scheduled for bulbar urethroplasty at our high volume center agreed to self-complete PROM-USS-Q pre-operatively, and between four and six months post-operatively. We undertook an in-depth psychometric assessment of the questionnaire constructs., Results: There was excellent correlation between change in voiding symptom score and change in Qmax (ρ=0.746) with parallel improvements in EQ-5D visual analogue and time trade-off scores demonstrating criterion validity. Test-retest reliability and internal consistency statistics were similarly robust: intra-class correlation coefficients ranged from 0.81 to 0.90 for the individual voiding questions. Cronbach's alpha was 0.79 for the overall score and ranged between 0.74 and 0.81. These indices exceeded our predefined reliability thresholds for inclusion. Statistically highly significant improvements in construct scores occurred following urethroplasty, demonstrating responsiveness to change., Conclusions: The PROM-USS-Q is a practical and robust instrument for assessing voiding symptoms and health-related quality of life following urethral stricture surgery.

Purpose: We compared posterior urethral strictures after pelvic fracture urethral distraction defects in India and Italy., Materials and Methods: We retrospectively analyzed the records of patients in India and Italy who underwent repair for posterior urethral stricture after pelvic fracture urethral distraction defect. We investigated etiology, emergency treatment type, the specialist involved in emergency treatment, the type of stricture resulting from trauma and primary repair, posterior urethroplasty techniques and results., Results: Of 255 patients with a median age of 33 years 117 (45.8%) and 138 (54.2%) were evaluated in India and Italy, respectively. In India the most common causes of pelvic fracture urethral distraction defects were pedestrian (35%), motorcycle (26.5%) and bicycle (12.8%) accidents. The most common emergency treatment was suprapubic cystostomy (79.5% of cases). Of the patients 70.1% were treated in emergency fashion by a surgeon and 85.4% had complex posterior urethral strictures. The most common technique was anastomosis with inferior and total pubectomy in 56.4% and 15.3% of cases, respectively. In Italy the etiology was mainly automobile accidents (39.2%). The most common emergency treatment was endoscopic realignment (49.2% of cases). Of the patients 92.7% were treated in emergency fashion by a urologist and 68.1% had simple urethral strictures. Perineal anastomosis and laser urethrotomy were the most used techniques (38.4% and 21.1% of cases, respectively). In India 92 cases (78.6%) were successful and 25 (21.4%) failed while in Italy 120 (86.9%) were successful and 18 (13.1%) failed. Median followup was 74 months (range 12 to 239)., Conclusions: Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results., (2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Our purpose was to evaluate patients who underwent failed hypospadias repair., Patients and Methods: We evaluated 4 different groups of patients who underwent failed hypospadias repair. Group 1: patients who underwent only urethral surgery; group 2: patients who underwent only corpora cavernosa surgery; group 3: patients who underwent urethral and corpora cavernosa surgery; group 4: patients who underwent complex reconstructive surgery. Success was defined as a functional urethra without fistula, with glandular meatus and acceptable esthetic appearance of the genitalia., Results: Out of 1,176 patients, group 1 included 301 patients (25.5%), group two 60 patients (5.2%), group three 166 patients (14.1%) and group four 649 patients (55.2%). The mean follow-up was 60.4 months. Out of 1,176 cases, 1,036 (88.1%) were considered successful and 140 (11.9%) failures., Conclusion: In the majority of patients (55.2%) with failed hypospadias repair, urethral reconstruction is associated with complex surgical procedures to fully resurface glands, penile shaft and genitalia., (Copyright © 2010 S. Karger AG, Basel.)

Objective: To determine the response rate to the self-administered Incontinence Impact Questionnaire (IIQ) in an Italian female population., Patients and Methods: 172 consecutive patients referred to the urogynecological department of an urban university teaching hospital were invited to answer the self-administered IIQ. Correlations were investigated between answer rate, age, educational status and urogenital pathology., Results: Only 41.6% of patients with low educational status answered all questions compared with 47.6 and 58% of medium and high educational status (p = 0.038 and p = 0.011 respectively). Mean patient age correlated inversely with educational status (rho = -0.443; p < 0.0001) and directly with non-response rate (rho = 0.207; p = 0.007). The non-response rate was correlated significantly and inversely with educational status only in continent patients (rho = -0.254; p = 0.037) and in patients with pelvic organ prolapse (rho = -0.256; p = 0.017)., Conclusions: The IIQ answer rate correlated directly with educational status in an Italian female population., (Copyright (c) 2009 S. Karger AG, Basel.)

Purpose: We performed a retrospective evaluation and statistical analysis of outcome in patients who underwent bulbar end-to-end anastomosis., Materials and Methods: We reviewed 153 patients with an average age of 39 years who underwent bulbar end-to-end anastomosis between 1988 and 2006. Mean followup was 68 months. Stricture etiology was unknown (62.7%), catheter (14.4%), blunt perineal trauma (11.7%), instrumentation (9.8%), radiotherapy (0.7%) and infection (0.7%). Stricture length was 1 to 2 cm (in 59.5%), 2 to 3 cm (37.9%), 3 to 4 cm (1.9%) or 4 to 5 cm (0.7%). A total of 90 patients (59%) underwent dilation, internal urethrotomy, urethroplasty or multiple procedures before being referred to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. The prevalence of postoperative sexual dysfunction was investigated using a nonvalidated questionnaire., Results: Of 153 cases 139 (90.8%) were successful and 14 (9.2%) were treatment failures. Treatment failure was managed with urethrotomy in 9 cases, end-to-end anastomosis in 2, buccal mucosal graft urethroplasty in 1 and 2-stage repair in 2. Of 14 cases of failure 12 had a satisfactory final outcome, 1 is still waiting for the second stage of urethroplasty and 1 underwent definitive perineostomy. There were 14 patients (23.3%) who experienced ejaculatory dysfunction, 1 (1.6%) a cold glans during erection, 7 (11.6%) a glans that was neither full nor swollen during erection and 11 (18.3%) had decreased glans sensitivity. No patients complained of penile chordee or impotence., Conclusions: Bulbar end-to-end anastomosis has a success rate of 90.8%. Most patients were satisfied with the surgical outcome despite postoperative complications such as ejaculatory dysfunction, a glans that was neither full nor swollen during erection, or decreased penile sensitivity.

The experience related to 1170 patients treated with electron beam between 1979-1988 at Radiation Therapy Department in Pisa is reported. Beam dosimetry and dose distribution in tissue, patients contour and other parameters have been analysed as main important factors to optimise this technique. Electron beam therapy offers important contributions to the management of peculiar types of cancer because of the radiotherapy treatments optimisation and the reduced normal tissue reactions.